|
OS CYP2C9 GENE COM VARIANTS
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 81227
|
| Hospital Charge Code |
30002006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$244.73 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$174.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$174.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$244.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$174.81
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$174.81
|
| Rate for Payer: Humana Medicare Advantage |
$174.81
|
| Rate for Payer: Kentucky WC Medicaid |
$176.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS CYP2D6 ANTIDEPRESSANT
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 81226
|
| Hospital Charge Code |
30000184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$631.27 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem Medicaid |
$450.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$450.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$631.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$450.91
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Humana KY Medicaid |
$450.91
|
| Rate for Payer: Humana Medicare Advantage |
$450.91
|
| Rate for Payer: Kentucky WC Medicaid |
$455.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$459.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
OS CYP2D6 ANTIDEPRESSANT
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 81226
|
| Hospital Charge Code |
30000184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.44
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
OS CYP3A5 GENE COMMON VARIANTS
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 81231
|
| Hospital Charge Code |
30002008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$244.73 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$174.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$174.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$244.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$174.81
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$174.81
|
| Rate for Payer: Humana Medicare Advantage |
$174.81
|
| Rate for Payer: Kentucky WC Medicaid |
$176.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS CYP3A5 GENE COMMON VARIANTS
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 81231
|
| Hospital Charge Code |
30002008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS CYSTIC FIB PROFILE 32 MUT
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
30000182
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$590.40 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.84
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.65
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
OS CYSTIC FIB PROFILE 32 MUT
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
30000182
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$779.24 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem Medicaid |
$556.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$556.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$779.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$556.60
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Humana KY Medicaid |
$556.60
|
| Rate for Payer: Humana Medicare Advantage |
$556.60
|
| Rate for Payer: Kentucky WC Medicaid |
$562.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$567.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.65
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
OS CYSTIC FIB PROFILE 97 MUT
|
Professional
|
Both
|
$631.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
30001800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$218.85 |
| Max. Negotiated Rate |
$631.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$631.00
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Healthspan PPO |
$218.85
|
| Rate for Payer: Multiplan PHCS |
$378.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.70
|
| Rate for Payer: UHCCP Medicaid |
$220.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$333.96
|
|
|
OS CYSTIC FIB PROFILE 97 MUT
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
30001800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$779.24 |
| Rate for Payer: Aetna Commercial |
$485.87
|
| Rate for Payer: Anthem Medicaid |
$556.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$556.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$506.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$779.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$556.60
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$523.73
|
| Rate for Payer: First Health Commercial |
$599.45
|
| Rate for Payer: Humana Commercial |
$536.35
|
| Rate for Payer: Humana KY Medicaid |
$556.60
|
| Rate for Payer: Humana Medicare Advantage |
$556.60
|
| Rate for Payer: Kentucky WC Medicaid |
$562.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$517.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$465.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$567.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$555.28
|
| Rate for Payer: Ohio Health Group HMO |
$473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.61
|
| Rate for Payer: PHCS Commercial |
$605.76
|
| Rate for Payer: United Healthcare All Payer |
$555.28
|
|
|
OS CYSTIC FIB PROFILE 97 MUT
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
HCPCS 81220
|
| Hospital Charge Code |
30001800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.03 |
| Max. Negotiated Rate |
$605.76 |
| Rate for Payer: Aetna Commercial |
$485.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$506.69
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cigna Commercial |
$523.73
|
| Rate for Payer: First Health Commercial |
$599.45
|
| Rate for Payer: Humana Commercial |
$536.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$517.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$465.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$555.28
|
| Rate for Payer: Ohio Health Group HMO |
$473.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$195.61
|
| Rate for Payer: PHCS Commercial |
$605.76
|
| Rate for Payer: United Healthcare All Payer |
$555.28
|
|
|
OS CYTOGENETIC STUDY
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
HCPCS 88299
|
| Hospital Charge Code |
30001501
|
|
Hospital Revenue Code
|
319
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$65.60 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem Medicaid |
$20.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.26
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Humana KY Medicaid |
$20.98
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$21.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.91
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
OS CYTOGENETIC STUDY
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
HCPCS 88299
|
| Hospital Charge Code |
30001501
|
|
Hospital Revenue Code
|
319
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$58.56 |
| Rate for Payer: Aetna Commercial |
$46.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$48.98
|
| Rate for Payer: Cash Price |
$30.50
|
| Rate for Payer: Cigna Commercial |
$50.63
|
| Rate for Payer: First Health Commercial |
$57.95
|
| Rate for Payer: Humana Commercial |
$51.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$50.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$45.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.68
|
| Rate for Payer: Ohio Health Group HMO |
$45.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.91
|
| Rate for Payer: PHCS Commercial |
$58.56
|
| Rate for Payer: United Healthcare All Payer |
$53.68
|
|
|
OS CYTOGENOMIC NEO MICROR ALYS
|
Facility
|
OP
|
$3,878.00
|
|
|
Service Code
|
HCPCS 81277
|
| Hospital Charge Code |
30001920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$504.14 |
| Max. Negotiated Rate |
$3,722.88 |
| Rate for Payer: Aetna Commercial |
$2,986.06
|
| Rate for Payer: Anthem Medicaid |
$1,160.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,160.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,114.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,624.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,939.00
|
| Rate for Payer: Cash Price |
$1,939.00
|
| Rate for Payer: Cigna Commercial |
$3,218.74
|
| Rate for Payer: First Health Commercial |
$3,684.10
|
| Rate for Payer: Humana Commercial |
$3,296.30
|
| Rate for Payer: Humana KY Medicaid |
$1,160.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,160.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,171.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,179.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,861.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,183.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,412.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,908.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$775.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.18
|
| Rate for Payer: PHCS Commercial |
$3,722.88
|
| Rate for Payer: United Healthcare All Payer |
$3,412.64
|
|
|
OS CYTOGENOMIC NEO MICROR ALYS
|
Facility
|
IP
|
$3,878.00
|
|
|
Service Code
|
HCPCS 81277
|
| Hospital Charge Code |
30001920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$504.14 |
| Max. Negotiated Rate |
$3,722.88 |
| Rate for Payer: Aetna Commercial |
$2,986.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,114.03
|
| Rate for Payer: Cash Price |
$1,939.00
|
| Rate for Payer: Cigna Commercial |
$3,218.74
|
| Rate for Payer: First Health Commercial |
$3,684.10
|
| Rate for Payer: Humana Commercial |
$3,296.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,179.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,861.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,163.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,412.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,908.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$775.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.18
|
| Rate for Payer: PHCS Commercial |
$3,722.88
|
| Rate for Payer: United Healthcare All Payer |
$3,412.64
|
|
|
OS CYTOMEGALOVIRUS IGG
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
30001140
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem Medicaid |
$14.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| Rate for Payer: Humana KY Medicaid |
$14.39
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Kentucky WC Medicaid |
$14.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.81
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
OS CYTOMEGALOVIRUS IGG
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS 86644
|
| Hospital Charge Code |
30001140
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$144.96 |
| Rate for Payer: Aetna Commercial |
$116.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.25
|
| Rate for Payer: Cash Price |
$75.50
|
| Rate for Payer: Cigna Commercial |
$125.33
|
| Rate for Payer: First Health Commercial |
$143.45
|
| Rate for Payer: Humana Commercial |
$128.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.88
|
| Rate for Payer: Ohio Health Group HMO |
$113.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.81
|
| Rate for Payer: PHCS Commercial |
$144.96
|
| Rate for Payer: United Healthcare All Payer |
$132.88
|
|
|
OS CYTOMEGALOVIRUS IGM
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
30001141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.24
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.26
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
OS CYTOMEGALOVIRUS IGM
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 86645
|
| Hospital Charge Code |
30001141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem Medicaid |
$16.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.85
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Humana KY Medicaid |
$16.85
|
| Rate for Payer: Humana Medicare Advantage |
$16.85
|
| Rate for Payer: Kentucky WC Medicaid |
$17.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.26
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
OS CYTOMEG PCR
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
30001859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.97
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
OS CYTOMEG PCR
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
30001859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$275.52 |
| Rate for Payer: Aetna Commercial |
$220.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.46
|
| Rate for Payer: Cash Price |
$143.50
|
| Rate for Payer: Cigna Commercial |
$238.21
|
| Rate for Payer: First Health Commercial |
$272.65
|
| Rate for Payer: Humana Commercial |
$243.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$235.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$252.56
|
| Rate for Payer: Ohio Health Group HMO |
$215.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.97
|
| Rate for Payer: PHCS Commercial |
$275.52
|
| Rate for Payer: United Healthcare All Payer |
$252.56
|
|
|
OS D2 FUNGAL SEQUENCING
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
HCPCS 87153
|
| Hospital Charge Code |
30001857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem Medicaid |
$115.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$115.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$161.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Humana KY Medicaid |
$115.36
|
| Rate for Payer: Humana Medicare Advantage |
$115.36
|
| Rate for Payer: Kentucky WC Medicaid |
$116.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS D2 FUNGAL SEQUENCING
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
HCPCS 87153
|
| Hospital Charge Code |
30001857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$178.56 |
| Rate for Payer: Aetna Commercial |
$143.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.36
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$154.38
|
| Rate for Payer: First Health Commercial |
$176.70
|
| Rate for Payer: Humana Commercial |
$158.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$152.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$137.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$163.68
|
| Rate for Payer: Ohio Health Group HMO |
$139.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$57.66
|
| Rate for Payer: PHCS Commercial |
$178.56
|
| Rate for Payer: United Healthcare All Payer |
$163.68
|
|
|
OS DANDELION IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000761
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS DANDELION IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000761
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
OS D DIMER QUANTITATIVE
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 85379
|
| Hospital Charge Code |
30000602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$10.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.18
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Humana KY Medicaid |
$10.18
|
| Rate for Payer: Humana Medicare Advantage |
$10.18
|
| Rate for Payer: Kentucky WC Medicaid |
$10.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
